"I'm a Real Person Too” The Im pact of Com m unication on Behaviour for People with Dem entia Presented by T. Bowser RNBN Illustrations by Don Bellamy
Introducing Don Bellam y “I’m a real person too.”
Outline What is communication? How does dementia affect communication? What does this mean for me as care provider? What do we do that may cause responsive behaviours? How can we reduce our contribution to responsive behaviours through communication?
What is com m unication?
What is com m unication? First Com m unications What are our first communications? What do they mean? Kit4na https:/ / www.flickr.com/ photos/ kit4na/ 6241060744/
What is com m unication? Function Of Com m unication Fundamental requirement for all human beings Essential for survival and growth and self-worth and belonging, identity Expression of needs Dignity Control Conveys meaning that goes beyond the spoken words
What is com m unication? Com m unication is a Process Like an ocean • Active • Continuous • Flowing • Changing If you look at one bucket sample you don’t see the whole picture If you look at a sentence word or gesture in isolation you do not get the whole message (– jacket)
What is com m unication? Com m unication is a Transaction Both individuals are affected by the other Complex interaction of skills Listening • Observing • Speaking • Questioning • Analyzing • Evaluating •
What is com m unication? Com m unication and Relationships A spoken sentence conveys much more than the information in the sentence – it is a reflection of the relationship Communication changes based on who you are talking to and in what situation
Consider the following paralinguistic features – what are your unique traits? Volume Rate of speech Tone of voice Pitch Hand gestures Eye contact Vocabulary Body language Emphasis Conversational cues (hmmm) Proxemics
What is com m unication? Let m e introduce m yself… Take a moment to introduce yourself to the person or people next to you Tell them your name, and a little bit about yourself then let them tell you about themselves Ask each other one question to find out more If you know the person beside you well, find someone new to meet as well
Reflect: What paralinguistic features do you use? What is your style? What did you sound like, look like? What were your partner’s features? This is normal communication
What is com m unication? Non Verbal Com m unication Communication is said to be 7% verbal, 93% non- verbal 38% tone 55% body language
What is com m unication? • Incongruence between verbal and non verbal
Com m unication and Dem entia Non-Verbals and Dem entia With dementia, people live in the here and now • May not rem em ber the details • May not be able to understand the details • They know how they feel and they retain the em otions from an interaction
Com m unication and Dem entia
Com m unication and Dem entia What happens with com m unication in dem entia?
Com m unication and Dem entia Dem entia Deficits of Com m unication Early Stages: • Tip of the tongue feeling • Takes longer to process – 30-60 seconds • Difficulty staying on track • Aphasia (word finding difficulty) • Repeating
Com m unication and Dem entia Dem entia Deficits of Com m unication Middle Stages • Forget more complex words • Neologisms • Increased generalizations • Greater reliance on social phrases • Difficulty following instruction • Less initiation of conversation
Com m unication and Dem entia Dem entia Deficits of Com m unication Late Stage • Single words • Limited initiation • Nonverbal sounds • Communication as a whole is predominantly nonverbal
Com m unication and Dem entia Other Com m unication Barriers Hearing loss • Loss of ability to hear higher pitches • Substantial hearing loss not unusual Vision loss • Many visual cues are used in communication • Conversational cueing • Feedback • Decoding Dentures
Com m unication and Dem entia Rem em ber: Lack of initiation/ engagement of conversation does not imply a lack of desire for communication Ability to UNDERSTAND the spoken word long outlasts the ability to COMMUNICATE the spoken word Ability to understand and experience the emotions involved in communication long outlasts the ability to understand the spoken word
Com m unication and Dem entia Results of Im paired Com m unication Unmet needs Frustration Anxiety Decreased self esteem Increased social isolation Interaction with individuals with dementia is often superficial and brief. o Not being understood increases isolation
Com m unication and Dem entia Results of Im paired Com m unication Responsive Behaviours Hostility Aggression Yelling Swearing Pushing Grabbing Refusing
What does this m ean for m e as care provider?
Com m unication and Dem entia Telephone Gam e? McGhee, J. (2011). Effective communication with people who have dementia Nursing Standard 25(25) 40-46
Com m unication and Dem entia Telephone Gam e? With increasing deficits, communication ceases to be 50/ 50 and becomes more 80/ 20
What we do… What do we do that m ay CAUSE responsive behaviours?
What we do… What do we do? How to we prom ote responsive behaviours? • Task orientation/ isolation • Removing control • Not engaging fully • Not responding to the emotion/ intended message • Elderspeak
What we do… Task Orientation/ Isolation Focusing on the task, not the person Only engaging with them when there is a task to be done
What we do… Rem oving Control • The desire to have control over ourselves and our lives is fundamental to people of all ages • We all want to feel as though we have influence over ourselves and our surroundings • Feelings of helplessness and loss of control lead to reduced cooperation and acting out • This is not unique to dementia…
Control. A life-long need.
What we do… Not Engaging Fully Multi-tasking Being disconnected Generic responses Back to them Talking to others as though they are not there
What we do… Not Responding to the Em otion Focusing only on the words Looking at the bucket of water Listening to reply rather than listening to understand
What we do… Elderspeak Dem eaning Nam es – Sweetie, Honey AVOID High Pitched Voice ELDERSPEAK Everything sounds like a question Baby Words – go potty App store?
What we do… Elderspeak • Greatly increases the likelihood of uncooperative behaviour when doing tasks • Demonstrates power imbalance and reinforces loss of control • Demonstrates lack of respect for individual and who they are • Increases depression and agitation • May be interpreted as abusive Even if dem entia is so advanced that the words are not understood, the feelings associated are perceived and retained
What we do… Elderspeak “Hi Sweetie. It’s time for our exercise today. Let’s get ready to walk down the hall.” Vs. “Hi Mrs. Smith. It’s time for your exercise today. May I walk down the hall with you?”
What we do… Elderspeak Effect on Person with Dem entia: • Feel incompetent • Feel discouraged • Feel disrespected • Alters self perception • Reinforces and imposes dependency • Insulting • Depression • Withdrawal Greatly increased likelihood of resistance to care
What we do… Herman, R & Williams, K. (2009). Elderspeak’s influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimer’s Disease and Other Dementias 24(5) 417-423
What we do… Elderspeak Effect on perception of care provider by third party and care recipient: • Disrespectful • Patronizing • Unprofessional • Angry • Frustrated • Dislikable • Unintelligent • Poor communicator
Strategies How can we reduce our contribution to responsive behaviours through com m unication?
Strategies Strategies Em pathic Curiosity • A standpoint of trying to focus our attention on the perceptual experiences of another as they are experiencing them here and now • More than empathy – empathic listening with maintaining a curious attitude toward nonverbal cues and behaviours Rem em ber: All com m unication has m eaning
Strategies - MESSAGE Strategies MESSAGE M – Maximize attention E – Expression and body language S – Simple S – Support the conversation A - Assist with visual aids G – Get their message (empathic listening) E – Encourage and engage in conversation
Strategies - MESSAGE M – Maxim ize Attention Give cues before engaging them Identify yourself Use their name Eye level and eye contact Remove distractions – quiet environment One person talking at a time May use touch to aid concentration Try it! – strike up a conversation w ith your neighbour
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